The story is all too common when clients come to our office. I was in a crash and went to the hospital that night. I felt lousy and followed up with an orthopedist. They took MRIs and told me that I have a disc herniation as a result of the car accident. It sounds scary and in some circumstances, it can have very serious consequences including surgery. So what does it mean? First things first. We will discuss what a disc herniation is from a medical standpoint and then we will discuss the implications.
What qualifies me to talk about this? Besides 15 years of experience in litigating herniated disc cases and having deposed over half of the orthopedic doctors in Atlanta, I myself have a herniated disc at L5-S1 with a surgical recommendation. I deal with leg and foot numbness daily and follow a strict physical fitness regimen to reduce the associated problems. When I tell you that I understand, I have walked in your shoes.
What is a Disc Herniation?
A cervical or lumbar disc herniation occurs when the disc between the bones of the spine ruptures. The discs are soft and flexible when we are young, but as we age, they become more rigid and can dry out.
This means that people over 30 are more vulnerable to disc herniations. When the disc herniates or ruptures, the disc changes shape and position and can pinch or irritate the adjacent nerves. This is even more true in people with spinal stenosis, a narrowing of the space around the spinal cord and nerves.
What are the Symptoms of a Herniated Disc?
When the adjacent nerves are irritated or pinched, the nerve misfires and can register several different sensations including:
Numbness and Tingling (Paresthesia)
One of the more common symptoms is a “pins and needles” feeling in the dermatome that corresponds to the disc level where the disc is herniated. See the diagram below for an illustration of cervical dermatomes. This is the fun that I get to experience every week. It is akin to the pins and needles you get from sitting on the throne for too long.
Pinching of the nerves can cause a sensation similar to an electric shock which will travel down the corresponding dermatome. Pressure on the nerves in the neck can lead to shocks in the arms and fingers and compression in the low back can cause the shocks to run down your legs.
Cauda Equina Syndrome
If you have a back injury and resulting problems urinating, with bowel movements or have numbness around the genitals, you may have cauda equina syndrome. This is a very serious medical emergency.
How is a Herniated Disc Diagnosed?
Most often, an emergency room will only x-ray the spine to ensure there are no fractures or other major displacements, but an x-ray cannot detect a herniated disc. If you experience any of the above symptoms, be sure to follow up with an Orthopedic Medical Doctor as suggested by the hospital. If after physical testing, your doctor determines that you have the symptoms, the Orthopedist may order an MRI, which is a highly sensitive imaging study that makes a detailed picture of this cross-section slices of your spine. On the dermatome chart above you will notice that the nerves leaving your spine at certain levels always correspond to pain or numbness in certain fingers, limbs and joints. By asking specific questions about where the numbness is, your doctor can learn a great deal about which disc level is causing the pain.
Your doctor will go over the MRI findings and your physical test results with you to determine what the best course of care is. There are several surgical options available including Microdiscectomy and Disc Fusion but these are options of last resort. Your doctor will likely advise that you start with a course of physical therapy. If that fails. the doctor may suggest a series of steroid injections or nerve cauterizations (also called a nerve ablation).